Summary & Overview
HCPCS J0572: Buprenorphine/Naloxone Oral, ≤3 mg Buprenorphine
HCPCS Level II code J0572 designates the oral combination formulation of buprenorphine and naloxone containing up to 3 mg of buprenorphine. This medication is a cornerstone in medication-assisted treatment (MAT) for opioid use disorder and carries national clinical and policy significance given the ongoing public health focus on opioid dependence and treatment access. Payers commonly covering this service in a national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers of this brief will find a concise explanation of the code’s clinical role, the typical service setting and use cases, and what to expect in payer coverage and billing practice. The publication also outlines available benchmarks and patterns where provided, notes common billing modifiers (input provided), and summarizes implications for clinical workflows and pharmacy dispensing. Where specific data elements were not supplied, the report identifies those gaps as "Data not available in the input." This summary is written for national stakeholders including providers, coders, and policy analysts seeking a clear reference on HCPCS Level II code J0572 and its place in outpatient medication management for opioid dependence.
Billing Code Overview
HCPCS Level II code J0572 represents buprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine. This code applies to the dispensing of a combined opioid partial agonist and opioid antagonist formulation used in the treatment of opioid dependence.
Service Type: Medication administration / Pharmacy-dispensed oral medication
Typical Site of Service: Outpatient pharmacies, clinic-based dispensing, and ambulatory care settings
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 32-year-old patient with opioid use disorder presents to an outpatient addiction medicine clinic for initiation or continuation of medication-assisted treatment. The patient reports craving control and reduced illicit opioid use after prior induction. The clinician performs a focused visit including assessment of withdrawal symptoms, medication reconciliation, and counseling. Buprenorphine/naloxone oral formulation in a low-dose presentation (≤3 mg of buprenorphine) is prescribed or dispensed for sublingual administration. Typical workflow steps include intake vitals and urine drug screen, clinical assessment for contraindications (respiratory depression, concurrent sedative use), determination of induction versus maintenance dosing, counseling on dosing and take-home instructions, and scheduling follow-up for dose titration and monitoring. Typical sites of service are outpatient clinics, behavioral health centers, community health centers, and office-based opioid treatment programs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no modifier applies to the claim. |
22 | Increased procedural services | Use when services required substantially greater work than typical (rare for medication dispensing visits). |